Medicare AdvantageCoverageMedium impact
Upper and Lower Extremity Magnetic Resonance Imaging (MRI) - Medicare Advantage (Revised)
Humana·Radiology, Orthopedics, Sports Medicine·Medicare Advantage
We identified it
Jul 2, 2026
Summary
This is a newly revised Medicare Advantage policy for upper and lower extremity MRI procedures. The policy document provides clinical background on MRI as a diagnostic imaging technique used to detect cartilage abnormalities, bone/soft tissue masses, and labral tears, but the summary-only format does not include specific coverage criteria, prior authorization requirements, billing codes, or effective dates needed for billing implementation.
Action Required
Immediately: Billing team must obtain the COMPLETE policy document from Humana (not summary-only version) using the source URL https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a569a1d to determine: (1) specific CPT codes covered (likely 70553, 70554, 73718, 73719, 73720, 73721 for extremity MRI), (2) prior authorization requirements, (3) medical necessity criteria, (4) effective date, and (5) any changes from prior version. Do NOT implement billing changes based on summary alone. Contact Humana provider services if full policy is not accessible. Flag this policy for follow-up once complete details are retrieved.